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The Euthansasia Debate. Dr M Feldman. Medical Ethics. Six of the values that commonly apply to medical ethics discussions are: Beneficence  - a practitioner should act in the best interest of the patient. ( Salus aegroti suprema lex .)

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Medical Ethics

Six of the values that commonly apply to medical ethics discussions are:

  • Beneficence - a practitioner should act in the best interest of the patient. (Salus aegroti suprema lex.)

  • Non-maleficence - "first, do no harm" (primum non nocere)

    .

  • Autonomy - the patient has the right to refuse or choose their treatment. (Voluntas aegroti suprema lex.)


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Medical Ethics

  • Justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).

  • Dignity - the patient (and the person treating the patient) have the right to dignity.

  • Truthfulness and honesty - the concept of informed consent


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Time for a change

Public opinion for  - 75 - 80%

Only doctors against

no evidence of slippery slope in Holland

Recent cases

  • Dianne pretty - mnd - wanted to avoid prosecution for husband

        English courts, appeal and European court refused


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Time for a change

  • Debbie Purdy-  MS Again courts have refused to give blanket exemption

  • Daniel James 23 yr old student English  rugby player - no prosectuion

  • Craig Ewert - MND - first televised euthanasia - Dignitas


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Time for a change

Why not here ? 

Patients could wait until needed

The reality of palliative care - personal experince

not for everyone - not for most


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Do you believe in Euthanasia according to Dutch Model

Y = 40%

N = 35%

Dont Know 25%

Would you be prepared to take part

Counsel only 50%

Take part 30%

Would not be involved 20%

Results of Questionnaire on Dutch Model


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Has the trip altered your views ?

    More in favour of euthanasia 75%

    Less in favour 5%

    My views are unchanged 20%

Results of Questionnaire on Dutch Model


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Tender loving care

Death without intervention

Palliative sedation

< 1-2 weeks before

expected death

Euthanasia


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Type of decision

2001

2005

Stopping or withholding of life-prolonging treatment

20,2%

15,6%

Terminal sedation without administation of fluids

5,6

7,1

Opioids with possible life-shortening effect

20,1

24,7

Ending of life

3,5

2,2

euthanasia

2,6

1,7

assisted suicide

0,2

0,1

without request

0,7

0,4


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Palliative sedation - definitions

Definition Health Council: “Bringing a patient in a condition of a deep sleep expecting to maintain it until the death of the patient.”

Royal Dutch Medical Association KNMG: “Deliberately lowering a patient’s consciousness in the last phase of life”


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Terminal / palliative sedation

Refractory symptoms

Life expectancy < 2 weeks

Proportional loss of consciousness

If necessary, until death

No intention to shorten life

Midazolam

Questions

Withholding food and fluids?

Alternative for euthanasia?

Source: Royal Dutch Medical Association, Palliative Sedation Guideline; 2002


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Euthanasia: due care criteria

Well-considered and durable request

Unbearable suffering without prospect of improvement

Proper information to patiënt

No alternatives according to patient and physician

Consultation of independent physician(SCEN)

Medically appropriate realisation


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American Views

  • Oregon - assisted suicide legal since Oct 97

    • Upheld by supreme court 2006

  • Washington - residents voted 58%to 42% for physician assisted suicide

    • Death within 6 months

    • Can get prescription for lethal drugs

    • Self administer

  • Psychiatric patients excluded


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American Views

  • Rarely used - only 541 Rx with 341 taken 98 - 07

    • Average age 69

    • white middle class

    • Slightly  more men

    • 86% in hospice programmes



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Euthanasia objectors

  • Go regularly to church ( whatever religion)

  • Oppose abortion

  • Oppose suicide

  • Oppose capital punishment

  • Worry about power of ' doctors' and dont trust them


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Changing opinions

Support for Euthanasia growing

  • Liberal Democrat MP Dr Evan Harris backed Ms Purdy's wish for assisted suicide

  • Scottish MP Margo Macdonald - attempt to  legalise assisted suicide

  • Now 38% of GP want ban lifted 

  •     Similar number would be prepared to be involved

  •     RCGP and BMA - remain opposed


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